Interim FDG-PET Scans Enable Response-Adapted Hodgkin Lymphoma Therapy

First analysis of data from an international RATHL study presented June 17 at the 13th International Conference on Malignant Lymphoma, held June 17-20 at Lugano, Switzerland, reported that interim Positron Emission Tomography (PET-CT) scanning has been successfully demonstrated to adapt treatment regimens for patients with advanced classical Hodgkins lymphoma.

Positron emission tomography (PET) is a nuclear medicine, functional imaging technique that produces a three-dimensional image of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Three-dimensional images of tracer concentration within the body are then constructed by computer analysis. In modern PET-CT scanners, three dimensional imaging is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine.

According to a report by Virginia Powers, PhD of OncLive — the official Website for the Oncology Specialty Group — the RATHL study results show that treatment could be intensified or de-escalated based on information revealed in the scans. Particularly notable was the finding that pulmonary toxicity can be decreased without loss of efficacy by omitting bleomycin from ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) in patients with a negative interim PET.

“We expect that ABVD will cure 70 percent of patients with advanced Hodgkin lymphoma, but it is desirable to de-escalate treatment in the best responders to avoid late toxicity,” observes Dr. Powers cites RATHL study leader and conference abstract presenter Peter Johnson, MD, of the Cancer Research UK Centre at the University of Southampton, UK. “This trial asked whether bleomycin can be eliminated from cycles 3 to 6 for the best responders without having an adverse effect on progression-free survival and whether the results in PET-positive patients can be improved by escalation to BEACOPP.”

Results of the study indicate that escalated therapy for interim PET-positive patients gives good subsequent response rates and promising PFS results, Dr. Johnson told Dr. Powers, although there was a higher false-negative rate for interim PET among patients with advanced stage disease. There were 53 deaths among participants during the study, 19 of which were disease related.

The abstract by PW Johnson, M Federico, A Fossa, et al., entitled “Response-adapted therapy based on interim FDA-PET scans in advanced Hodgkin lymphoma: first analysis of the safety of de-escalation and safety of escalation in the international RATHL study,” was presented at the 13th International Conference on Malignant Lymphoma, held June 17-20, 2015; Lugano, Switzerland. Abstract 008.

Dr. Virginia Powers’ full OncLive report can be found at:
http://bit.ly/1HkXkDP

Sources:
OncLive
13th International Conference on Malignant Lymphoma

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